Welcome to the WSC 2022 Interactive Program

Background and Aims

Prevalence and risk factors of wake up stroke patients in Indonesia is still limited. This study aim to identified the prevalence and risk factors of wake-up ischemic stroke.

Methods

Data were collected from the Stroke Registry in National Brain Center Hospital Jakarta between January 2022 and June 2022. Data included demography, clinical comorbidities and BMI. We performed cross sectional study and analyzed multivariate logistic regression using STATA 16 ver to establish independent factors for increasing the risk of wake-up ischemic stroke.

Results

From 928 ischemic stroke patients, 258 (27.8%) patients had wake-up stroke. In multivariate data analysis, the risk factors of wake-up stroke was more common in patient with hyperuricemia (OR 1.693 (95% CI, 1.133-2.530) p-value 0.010).

Conclusions

Risk factors between wake-up stroke ischemic and non wake-up stroke ischemic were relatively similar, except for hyperuricemia. Further study with cohort design is recomended.

Background and Aims

Acute ischemic stroke can rarely present with severe headaches without focal deficits. Unilateral thunderclap headache is an uncommon entity in stroke patients, but here we present a case of a 46-year-old female with right-sided thunderclap headache following acute ischemic stroke in the left portion of the splenium of the corpus callosum.

Methods

A 46-year-old lady with a previous history of hypertension presented in the clinic with sudden onset, bursting type, and very severe right hemi-cranial headache 2 days back. The headache occurred while she was washing utensils, and was very severe and violent. The intensity decreased slightly after taking analgesic at home, but not subsided completely.

The patient came to our clinic in view of the non-resolving severe headache, despite analgesic treatment. On presentation, her BP was 150/90 mmHg with no associated neck rigidity, cranial nerve, motor, or sensory deficits. Fundus was normal.

Results

MRI brain of the patient was suggestive of diffusion restriction in the left portion of the splenium of the corpus callosum with normal MRA and MRV suggestive of acute ischemic stroke. The patient was started on aspirin, atorvastatin, propranolol, and flunarizine immediately in view of the headache associated with ischemic stroke. Her headache gradually improved and subsided completely over a period of 10-15 days.

Conclusions

Unilateral thunderclap headache in this patient was associated with ischemic stroke of the corpus callosum. The possible pathophysiological mechanism behind this patient’s headache may be the generation of cortical spreading depression further leading to activation of the trigeminovascular system similar to that noticed in migraine.

Background and Aims

Dysphagia (swallowing difficulties) is common post stroke and an independent predictor of poor outcome, but there are no standardised treatment guidelines. Pharyngeal electrical stimulation (PES) is licensed for use in the UK and Europe but lacks a definitive evidence-base and so is not widely used. We aim to assess whether PES is safe and effective at improving post-stroke dysphagia.

Methods

PhEAST is an international prospective, randomised, open-label, blinded-endpoint (PROBE) trial. 800 adults with recent (4-21 days) ischaemic or haemorrhagic anterior or posterior circulation stroke, and clinical dysphagia with a reliance on non-oral nutrition will be recruited.

Patients will be randomised (1:1), with stratification on country and minimisation on age, sex, dysphagia severity rating scale (DSRS), impairment, stroke type, circulation and time to randomisation, to receive either PES or No PES. The PES group will receive six, once daily (10 minute) treatments of PES. Both groups will receive standard dysphagia rehabilitation.

Results

The primary outcome is dysphagia status, assessed using the Dysphagia Severity Rating Scale (DSRS) at day 14. Secondary outcomes include PES threshold and tolerability at day 7, dysphagia status, dependency, disability, quality of life, cognition, mood and disposition at 90 and all-cause mortality at day 365.

Conclusions

PhEAST will provide definitive evidence for the use of PES in acute stroke. The results may directly inform clinical decision making and support decisions on guidelines for standardised practice in dysphagia treatment.

Background and Aims

When a patient who complains of persistent severe headache of abrupt onset comes to the hospital, we, neurologists, usually focus on intracranial pathology as well as a primary headache. However we can overlook or miss other systemic causes of headache.

Methods

A 53-year-old man was hospitalized due to severe headache occurred abruptly three days before presentation. Headache persisted. The patient denied a recent history of infection and had not received any recent vaccination. He only had a medical history of diabetes mellitus. Neurological examination did not show any specific findings. Serum exams were normal, as well as liver and renal function tests. To rule out intracranial lesions, brain MRI and angiography were performed, MR Venography was performed subsequently to rule out Cerebral venous sinus thrombosis. No specific findings were found in these examinations. CSF study was unremarkable. Severe headache persisted with excessive sweating was seen.

Results

In computed tomography (Figure1. (A), (B)), about 4cm diameter left adrenal gland mass was detected. A MIBG scan (Figure 1. (C)) was performed, increased uptakes at the left adrenal mass. The patient started taking alpha-blocker under the diagnosis of pheochromocytoma. After surgical removal of pheochromocytoma, he returned to normal with his symptoms subsided.

Conclusions

A triad symptom of paroxysmal headache, excessive sweating, and heart palpitations raise suspicion of a pheochromocytoma. As above, not only neurological problems but other causes can cause headache as the only symptom. Therefore, if symptoms persist or get worse, further evaluation should be required to find out other systemic causes that can cause severe headaches.

Background and Aims

The most common ocular motor paralysis in adults is the abducens (NVI) nerve palsy. Damage or disruption to the abducens nerve anywhere along its long intracranial course can result in a palsy. The most common causes are microvascular ischemia, trauma, neoplasm, aneurysm or it can be due to conditions leading to elevated intracranial pressure.

Methods

We are presenting a case of a young female patient, age 37, after preeclampsia, spontaneous intrauterine death of a fetus and C-section.

Results

Convergent strabismus of the left eye and double vision with acute onset one hour after a cesarean section. 24 hours later patient complaint for severe headache, nausea and vomitus. CT of the brain was preformed and it was normal. Brain MRI with TOF and venography was performed and thrombosis of the left transversal sinus, sigmoid sinus and sinus confluence was found without focal brain lesion. On the ophthalmological examination bilateral papilledema was seen as a result of elevated intracranial pressure. Blood tests, Holter ECG, extracranial ultrasound of the carotid and vertebral blood vessels and EEG were made as well and all were normal. Echocardiography showed thickened interatrial septum after ASD closure without color Doppler visible shunt.

Conclusions

Positive SS-A/Ro RNPA autoantibodies, 1.68 times higher values for antinuclear autoantibodies, positive PrC, homozygotic mutations for eNOS G894T and PAI-1 5G/4G, heterozygotic mutations for MTHFCR A1298C,MTHFR C677T, MTR A2756G, fV Leiden, fII G20210A and fXIII V344, history of previous spontaneous abortion, small and full with microinfarctions placenta were found as a probable cause for cerebral venous thrombosis at discharge.

Background and Aims

Two clinical cases of cerebral venous thromboses (CVT) deserved our attention. A 65 years old female patient (A) came to our observation for dizziness. At case history, she referred arterial hypertension, past occipital ischaemic stroke, related to thrombosis of the distal branch of the posterior cerebellar artery. Another 37 years old female patient (B), with low body mass index, affected with phocomelia, episodes of cephalalgias, generalized epileptic seizures, dizziness, underwent Magnetic Resonance Imaging (MRI) for cranial trauma, showing transverse sinus thrombosis.

Methods

Both patients underwent blood withdrawal, Electroencephalogram, Echo-Doppler, Echocardiography, 24 hours Holter Electrocardiogram, MRI with angio-sequences (angio-MRI), contrast-enhanced Computerized Tomography (CT).

Results

In A patient, angio-MRI showed diffuse right, transverse sinus thrombosis, confirmed at CT, with initial extension to the left side. Therapy with warfarin was prescribed. Because mild anemia was revealed and faecal occult blood was positive before reaching therapeutical window, esophago-gastro- duodenal and colon endoscopies were performed, which showed hiatal hernia, hyperemic-erosive gastropathy, external, congested haemorrhoids, sigmoid diverticulosis, a benign, small polyp in transverse colon. A shift to low molecular weight heparin was performed. In B patient, a spontaneous, partial recanalization of transverse sinus thrombosis was observed, and acetyl-salicylic acid was prescribed.

Conclusions

Few studies are available on CVT treated with novel oral anticlotting therapies (NOACs: dabigatran, rivaroxaban). The most appropriate, pharmacological attempt for our patients would have been apixaban. Further studies are needed in order to validate efficacy and safety of NOACs in CVT, the duration of prescription, especially if genetic polymorphisms linked to CVT are identified.

Background and Aims

Dysphagia following stroke is linked to high mortality and low outcomes of rehabilitation. Its presence portends serious consequences such as aspiration pneumonia and death. Hence, improving feeding is important for stroke survivors (SSv) with dysphagia. Therefore, this study explored the efficacy of structured-physiotherapy among SSv with dysphagia

Methods

This study involved eight stroke patients with dysphagia from an acute stroke unit (ASU) in Nigeria. Stroke severity, and swallowing and feeding abilities were assessed using National Institute of Health Stroke Scale (NIHSS) and Functional Oral Intake Scale (FOIS) respectively. Their clinical features were documented objectively while their socio-demographics and health histories were obtained through interview. They all received physiotherapy daily for 2-4weeks. Data were analysed using Wilcoxon signed-ranks test and Chi-square

Results

Out of 48 SSv in the ASU, 8 were had dysphagia (16.67% prevalence) and participated in the study. Six of them completed this study while 2(25%) died. Most (75%) were females, first-ever stroke (87.5%) and ischemic stroke (62.5%) with mid-brain lesion (62.5%) . Their age was 42-85years (mean=69.25±15.41years). Their FOIS score (1.0±00) at NIHSS score (20.88±5.36) at baseline improve significantly (0.004) to 3.00±2.33 at post-intervention. There was significant linear association (p=0.03) between stroke severity and swallowing and feeding at baseline. All the participants were able to feed and swallow within the first 2weeks of the intervention.

Conclusions

Dysphagia is common is stroke and it is associated with stroke severity. it is common in ischaemic stroke with mid-brain lesion. Early physiotherapy is effective in improving swallowing and feeding in stroke survivors with dysphagia.

Background and Aims

The current stroke research funding environment is highly competitive, stifling collaboration and hindering progress. Further, specific groups of researchers/research topics are disproportionately affected, resulting in inequity in the funding process (e.g., early-career-researchers (ECR), women, and researchers from low-middle-income countries, rare stroke-related diseases). Currently, there is no easy way for people working on such topics to collaborate. To address this problem, a novel internet-based platform, Collavidence (www.collavidence.com), was designed. The idea is to complement current systems of stroke research collaboration and funding for more inclusive, efficient, and impactful research results. The aim of this study is to present the initial performance of the platform in achieving this goal.

Methods

User engagement will be assessed by weekly registration rate in the first six months following launch of the platform (March 30th, 2022), as well as the number of projects posted, the amount of funding accumulated, the proportion of successfully funded projects, and the iterative improvement of the proposals. Further, the relative engagement of ECR, female researchers, and researchers from low-middle-income countries will be assessed and presented in comparison to traditional granting agencies.

Results

Qualitative assessment of the value of the overall platform, the process of iterative review, and possibilities for collaboration will be presented. Trends in the first six months of platform engagement and the relative distribution of specific user demographics, to assess the platform’s success in encouraging equity, diversity, and inclusion, will be discussed.

Conclusions

This study will discuss the feasibility of Collavidence as a unique platform for stroke research collaboration and funding.

Background and Aims

Cerebral venous thrombosis (CVT) is presence of blood clot in the intracranial venous system. Gender-specific risk factors includes oral contraceptives (OCP), pregnancy and puerperium. OCP has been associated with an increased risk of both venous and arterial thrombosis. This study observed a homogenous subgroup of population taking OCP and suffering from CVT.

To describe the demographic, clinical profile, indication, type and duration of OCP used in cases of CVT seen at our institute, its imaging correlates and outcome.

Methods

Retrospective hospital-based study conducted at our institute over the past 11 years (2010-2020) with the help of medical records available at Record Section.

Results

Out of 98 females included, most of them presented with headache (94.9%). Majority had GCS of >9 (85.7%). The most common OCP used was combined OCP (63.3%), followed by progestin only pill (30.6%), abortifacients (6.1%), non-hormonal (4.1%) and emergency contraception (2.1%). Amongst combined OCP, second generation (72%) was maximum used. Mean duration of OCP was 125.8 days ± (SD=168.42 days). Duration of symptoms had significant association with duration of combined OCP used. Majority had parenchymal lesion (74.5%) and most common sinus involved was transverse sinus. Most had good outcome at discharge (81.6%). Predictors of poor outcome were motor deficits, altered sensorium, speech and language involvement, low GCS and need for surgery.

Conclusions

This is a unique study, previously not conducted in India. Besides combined OCP, this study has revealed new data with respect to CVT caused by other types of OCP. Hence, further long-term future studies are required.

Background and Aims

Rapid stroke recognition and early initiation of specialized care interventions decrease mortality and complications. ROSIER is a clinical instrument to diagnose stroke in the ER. This study aims at determining the diagnostic value of the ROSIER in the diagnosis of stroke.

Methods

patients who were referred to the ER and were suspected of having a stroke were included, according to the inclusion and exclusion criteria. At the beginning of the patient presentation, the ROSIER score was completed by an emergency medicine specialist.

Results

189 patients were included in this study. The area under the curve in the ROC curve for ROSIER with stroke diagnosis was 0.763, indicating the relatively good use of the test. The sensitivity was 96.49%, the specificity was 5.56%. The PPV was 90.66%, and its NPV was 14.29%.

Conclusions

The high score of ROSIER indicates a stroke diagnosis, and as a result, the patients’ length of stay in the ER will be reduced. ROSIER scale has high sensitivity and high PPV in the diagnosis of stroke. Though, it is not promising in ruling out the disease and has a low specific specificity and NPV. Even though it has low specificity, the high sensitivity and high positive predictive value of this criterion reduce the chances of missing a critically ill patient. As a result, it is recommended to be used in ER.

Background and Aims

Few scoring systems are used in the emergency department to identify critically ill patients and anticipate patient's deterioration such as National Early Warning Score (NEWS). This study aimed to evaluate NEWS in patients with acute stroke and its relationship with treatment and type of stroke and patient outcome.

Methods

In this prospective cross-sectional descriptive-analytical study, all patients over 18 years of age with a diagnosis of ischemic stroke, who presented through the emergency department, were involved. The variables of interest were collected; NEWs score was calculated for each patient.

Results

In assessing NEWS and its relationship with outcome-based on ROC curve, the area under the curve (AUC) was equal to 0.417. Considering the high intensity of NEWS above 7, sensitivity, specificity, positive predictive value, negative predictive value, PLR, and NLR were 16.67%, 98.77%, 83.33%, 74.45%, 13.5, 0.84 respectively. In assessing NEWS and its relationship with stroke-type on ROC curve, the (AUC) was equal to 0.526. Considering the high intensity of NEWS above 7, sensitivity, specificity, positive predictive value, negative predictive value, PLR, and NLR were 8.33%, 94.95%, 16.67%, 88.53%, 1.65, and 0.97 respectively.

Conclusions

In terms of outcome, NEWS seems to have acceptable specificity and positive and negative predictive values. Regarding the type of stroke, NEWS has an acceptable specificity but it only has a negative predictive value about the non-hemorrhagic type of stroke. This means that if the NEWS number is LOW, the probability is that the type of stroke is ischemic and the patient outcome is good.

Background and Aims

Due to COVID-19 pandemic , face to face clinics were suspended at Russells Hall Hospital in Dudley. This in turn increased long waiting period for patients. Also, patients were skeptical to attend face to face clinics due to COVID-19 pandemic.So,virtual clinics was initiated.

Methods

Prospective survey of patients who attended stroke/TIA virtual clinics in the span of 3 months. A total of 50 patients (Stroke/TIA) participated in this survey.

All the patients were above the age of 18 years, consent was taken from all the patients who participated in the survey.

Results

Nursing and care-home staff were extremely happy with virtual clinics as nursing team could also be present with the patients for their clinic appointments. Also, there was no need to book transport or arrange escort for the patients.Patients suggested to start video consultation clinics.
2% of the patients who were dissatisfied with the virtual clinics provided the feedback that they rather preferred the conventional face to face clinics over Virtual clinics.After carefully analysing the feedback given in the survey, we are planning to introduce video consultantion clinics for TIA patients.

Conclusions

Majority of patients who attended Virtual TIA clinics were satisfied with this approach, as virtual clinics were convenient to adhere for the doctor’s appointment, avoids travelling to hospital and saves waiting time in the waiting area at the outpatient’s department. Based on the feedback provided by the patients in the survey we are introducing Attend Anywhere video consultation in our TIA clinics.

Background and Aims

The NIHSS score is used to quantify the extent of neurological deficit following stroke and to aid in treatment decision. The aim of this study is to highlight presentations of acute ischemic stroke with NIHSS score of zero.

Methods

This was a prospective observational study enrolling consecutive patients with acute ischemic stroke presenting between february 2021 and february 2022 with zero NIHSS score at presentaion. Clinical history with neurological examination and MRI brain with MRA were performed in all.

Results

A total of 24 patients presented with zero NIHSS score. Clinical features at presentation are elucidated in table 1. 16 patients presented with combination of one or more of the above symptoms while 8 patients presented with a single clinical feature. Location of acute infarcts in MRI is summarised in Table 2

According to TOAST classification 5(21%) had cardioembolic stroke, 4 had large vessel atherosclerosis(16%), 6(25%) had small vessel ischemia and 9(37%) were cryptogenic.

Conclusions

Presentation with zero NIHSS score was more commonly observed in posterior circulation strokes than anterior circulation strokes. High index of suspicion is required for prompt identifaction and appropriate management to avoid long term disability.

Background and Aims

Measuring health-related quality of life (HRQoL) in people with aphasia (PWA) brings a great advantage in the implementation of speech-language intervention. No method focusing on the HRQoL of PWA has been available in Slovakia so far. Our pilot study aimed to prepare the Slovak adaptation of the Aphasia Impact Questionnaire-21 (AIQ-21; Swinburn et al., 2018).

Methods

By analyzing available methods for assessing HRQoL in PWA, we decided to adapt AIQ-21 (Swinburn et al., 2018). The deciding factor was the active involvement of PWA in the development of the questionnaire and administration time. Six PWA in a chronic stage were actively involved in the adaptation. Patients provided feedback on the content of each item in the Slovak version.

Results

The result was an officially available Slovak adaptation of the AIQ-21 questionnaire called Dotazník vplyvu afázie (AIQ-21sk; Mackulin, Cséfalvay, 2021). PWA confirmed that the questions were clear, concise, and eloquent. They experienced a positive change from linguistical tests focusing on their weaknesses. The tool is suitable for people with chronic aphasia without severe language comprehension impairment.

Conclusions

Our method provides the first HRQoL assessment tool for Slovak PWA. The data obtained are a source of information for speech-language diagnostics and therapy. Main benefits for practice:

for clinical speech-language pathologists

(1) understanding the client's subjective view of his HRQoL,

(2) helps set therapy goals,

(3) suitable tool for measuring effectiveness of therapy,

for PWA

(1) involves the individual in the decision of providing care,

(2) allows priorities of all stakeholders to be taken into account, (3) sense of equivalence.

Background and Aims

Ideational Apraxia (IA) and Transcortical Sensory Aphasia (TSA) are often observed in patients with extensive left hemisphere damage. Difficulty in sequencing actions, phonological processing, and complex motor planning may not represent higher-order motor programming or higher-order complex formation. We aimed to report visual and motor skill effects on IA, TSA, and associated stroke individuals.

Methods

Twelve bilingual participants (seven males, five females) were diagnosed with IA and TSA. Twelve healthy control individuals were also assessed. Motor skills, including coordination, visual-motor testing, and phonological processing, were examined via Bilingual Aphasia Testing (BAT) and appropriate behavioral evaluation in study participants. First and second language (L1, L2) speech production was taken into consideration.

Results

Findings showed that L1 and L2 group performance in pointing skills was statistically significant (p<0.001) in healthy individuals compared to IA and TSA group cohorts. In healthy individuals compared to IA and TSA counterparts, command skills for L1 and L2 groups were significant (p<0.001). Orthographic skills for IA and TSA individuals were significantly decreased (p<0.01) when nearing two months compared to healthy counterparts. Visual skills were significantly improved (p<0.05) in IA and TSA individuals in the L1 group than in healthy controls nearing two months.

Conclusions

Both motor and visual-motor functions contribute to dyspraxia, with patients demonstrating poorer motor skills in practical categories. The current dataset indicates dyspraxia in sensory disorders and cerebellar movement control mechanisms alongside cortical networking implicated in praxis. Reinforcing skills and functionality alongside IA and TSA treatment highlighting motor dysfunction may be a good predictor for treating semantic disorders.

Background and Aims

Ischemic stroke is caused by a thrombotic or embolic occlusion of a cerebral artery, resulting in a sudden loss of blood circulation to an area of the brain and resulting in neurological dysfunction. Lesions in the motor cortex in ischemic stroke will cause paresis or weakness, causing functional impairment for the sufferer. In addition, abnormalities in hemoglobin levels, hematocrit, and mean corpuscular volume related to the severity of ischemic stroke can be observed through the degree of muscle strength.

This study aims to determine the relationship between hemoglobin, hematocrit, and mean corpuscular volume with the degree of muscle strength in ischemic stroke patients at Anutapura Hospital and UPT Undata Hospital Palu

Methods

The type of research used is an analytical method with a cross-sectional approach. The data collection used was consecutive sampling, namely the technique of accessing the sample by taking into account the inclusion and exclusion criteria

Results

Analysis of research results using Spearman rho found that there was no relationship between hemoglobin (r=˗0.139) and (p=0.28), hematocrit (r=-0.092) and (p=0.476) and mean corpuscular volume (r=0.025) (p=0.847) which is significant (p > 0.05)

Conclusions

There is no relationship between hemoglobin levels, hematocrit, and corpuscular volume with muscle strength in ischemic stroke patients at Anutapura General Hospital and UPT Undata Hospital Palu

Background and Aims

There are numbers of prognostic tools to assess the outcome of stroke patients. National Institutes of Health Stroke Scale(NIHSS), modified Rankin Scale (mRS), and modified stroke subtype, Oxfordshire Community Stroke Project classification, age, and pre-stroke modified Rankin (mSOAR), have been widely used to stratify patient prognosis. This study aims to compare the accuracy, sensitivity, and specificity of NIHSS, mRS, and mSOAR in predicting mortality in acute stroke patients.

Methods

A retrospective study at General Hospital Dr. Moewardi, Indonesia, was conducted involving all acute stroke patients in 2021. NIHSS, mRS, and mSOAR were obtained on the first day of admission, and the patient's outcome was observed on discharge from the hospital after the acute phase. We used receiver operating characteristic (ROC) curves to compare the accuracy, sensitivity, and specificity of each instrument in predicting patient mortality.

Results

A total of 160 patients were included in this study. We found that NIHSS, mRS, and mSOAR scores were significantly higher in those who died (p<0.05). mSOAR (AUC=0.743) had the highest AUC (Area Under Curve) compared to mRS (AUC=0.691) and NIHSS (AUC=0.739); however, the NIHSS had the highest sensitivity (92.3%). The sensitivity of mRS and mSOAR were 38.5% and 46.2%, respectively. The NIHSS, mRS, and mSOAR specificities were 56.5%, 91.8%, and 95.9%, respectively.

Conclusions

The NIHSS has high sensitivity in predicting patient mortality. While mSOAR has the highest AUC value and specificity in predicting patient mortality, but its sensitivity is relatively low.

Background and Aims

Cerebral venous sinus thrombosis (CVST) is oftentimes challenging to diagnose during the first hospital admission due to the variability of the symptoms and clinical features. This condition may be wrongly diagnosed as an acute psychiatric disorder which could delay a proper case management. A problematic case is reported, highlighting the importance of a meticulous anamnesis as well as the doctor’s awareness of this particular condition when evaluating such a potential case.

Methods

In order to assess the initial CVST symptoms, the thrombosis of the cerebral veins cases hospitalized in the Neurology department during the 2015-2022 period were evaluated. In 5 cases the CVT debut occurred immediately postpartum (50% of all the cases), the patients showing focal motor seizures and/or persisting headache. In 1 case only the dominant symptoms were of a psychiatric nature, starting at approximately 10 days postpartum which led to the patient initially being hospitalized in the psychiatry ward with the diagnosis of postpartum depressive disorder. The psychiatric symptomatology persisted under specific medication which, in association with a non-pharmacologically responsive headache, prompted more thorough investigations such as a cerebral MR angiography with contrast, exposing a left transverse and left sigmoid sinus thrombosis.

Results

Afterwards, anticoagulant therapy has been initiated with favourable outcome, the cerebral MR angiography at the 3-month mark after the symptoms’ debut showing cerebral sinus veins reperfusion.

Conclusions

Thrombosis of the cerebral veins is an unusual and strenuous diagnosis, with unpredictable symptoms and prognosis. The nonspecific initial symptomatology may lead to an improper diagnosis and delay in properly managing the case.

Background and Aims

The impact of anemia on mortality and functional outcomes following acute ischemic stroke (IS) has been controversial in the literature. The aim of this study was to evaluate the prevalence of anemia among patients with first-ever IS and its impact on neurological state in the acute phase of the disease and the degree of disability in follow-up.

Methods

The prospective study included 549 patients with the first-ever IS. Each patient underwent CT of the head and blood tests, including hemoglobin (Hb) concentration on the first day of hospitalization. We have analyzed the neurological state on the first day of stroke by NIHSS and the functional status at 6 months after the onset of stroke by the modified Rankin scale (mRs) in patients with and without anemia.

Results

Of the study population, 153 patients (27.9%) were anemic. Multivariate analysis revealed that patients with anemia had a higher NIHSS score on admission (p<0,001). During the acute phase, 14 (9,2%) and 12 (3%) of the patients in the anemic and control groups, respectively, died (p=0,002). Within 6 months of initial onset, the mortality rate was significantly higher in patients with anemia (p = 0.013). Patients with anemia significantly more often achieved a score of 3-5 points on mRs at 6 months after the onset of IS (p <0,001).

Conclusions

Anemia was frequent among our patients and was an independent predictor of short and long-term mortality and poor functional outcomes in patients with first IS.

Background and Aims

NeuroAiD (MLC601 and MLC 901) is a combination of natural products shown to have neuroprotective and neuroproliferative properties which were elucidated in various preclinical and clinical studies. NeuroAID Safe Treatment Registry (NeST) aims to assess the use and safety of NeuroAiD in real world settings.

Methods

Patients taking or prescribed NeuroAiD and have agreed to participate were included in the study. Clinical data were prospectively entered through an online system and collected at baseline and month 1 to 3. Outcome measures included National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), modified Rankin Scale (mRS) and Short Orientation Memory-Concentration Test (SOMCT). Primary Outcome included safety through the reporting of adverse events, while compliance and neurological status are the secondary outcome measures.

Results

A total of 735 patients were enrolled. Mean age was 58.9±15.4yr,58% were male. Comorbidities included hypertension (70 %), diabetes (23%), hyperlipidaemia (33%), cardiac disease (16%), and smoking (13%). Stroke accounts for 69%, intracerebral haemorrhage 15%, traumatic brain injury 7.6%. 60 -80 % were compliant. At month 3, the mean NIHSS is 5 (± 5.47), the mean mRS 1.9 ±1.5 with greater proportions of patient achieving improvement in mean score from baseline. The SOMCT however, showed decline from baseline to month 3.

Conclusions

Real world data showed MLC601/MLC901 is safe and has therapeutic potential, with good compliance.

Background and Aims

The clinical construct of embolic stroke of undetermined source (ESUS) was introduced to identify patients with non-lacunar cryptogenic ischemic strokes in whom embolism was the likely stroke mechanism. Many conditions may lead to cerebral embolism, making embolic stroke a heterogeneous entity. The heart is the major source of emboli. The aim of our study is to discuss the role of echocardiography in clinical practice.

Methods

We performed a descriptive, retrospective study covering a period of 6 years from January 2015 to December 2020 and including patients hospitalized for ESUS in the neurology department of military hospital for instruction of Tunis. We included patients with a non-lacunar cerebral infract and without proximal arterial stenosis or major cardio-embolic sources.

Results

We collected a total of 63 patients. The average age of the patients during the stroke was 58 years with extremes ranging from 29 to 80 years. 62 patients were explored by a trans transthoracic echocardiography. Ten patients underwent transesophageal echocardiography. The main abnormalities detected on echocardiography were cardiac wall motion abnormalities, mild heart valve diseases, left atrial enlargement and aortic atheroma. Recurrent ischemic strokes occurred in 13 patients. We identified mild heart valve diseases and wall motion abnormalities as predictive factors of recurrence.

Conclusions

Echocardiography plays an important role both in the diagnosis and the management of ESUS and should be performed as soon as possible for preventing ischemic stroke recurrencies.

The identification of stroke etiology allows better targeting of its primary or secondary prevention.

Background and Aims

Nearly 50 single-nucleotide variants (SNVs) have been previously reported to be significantly associated with risk of ischemic stroke (IS), but whether these SNVs are IS subtype-specific or associated with stroke outcomes remains unclear. We systematically investigate association between these SNVs and subtypes or outcomes of IS.

Methods

Forty-seven SNVs, which derived from previous genome-wide association studies, were genotyped. Causative Classification of Stroke subtyping was recorded. We conducted association analyses among genotypes, stroke subtypes or outcomes, and ten related vascular traits of 7,674 patients with first-ever IS/transient ischemic attack (TIA) from the Third China National Stroke Registry-III. We further conducted causal inference tests (CIT) to infer the potential mediated pathways.

Results

We identified 12 out of 42 SNVs (after excluding 2 SNVs with failed genotyping and 3 SNVs with no polymorphism) were associated with IS subtypes, of which 6 (near PITX2) and 2 (near ZFHX3) were cardioembolic stroke (CE)-specific. Ten SNVs from 3 loci (PITX2, ABO, ZFHX3) had genetic overlap between certain IS subtype and 2 or more related traits. CIT suggested that atrial fibrillation mediated the association between 3 SNVs near PITX2 and CE. Four SNVs (in ZFHX3 and HDAC9) were associated with composite vascular events and recurrent stroke only in CE or undetermined causes subtypes. The SNV in PDE3A was associated with both outcomes.

Conclusions

Our study has identified unique SNVs among stroke subtypes, novel associations between the SNVs (in ZFHX3, HDAC9, PDE3A) and stroke outcomes. These results suggest potential causal insights into pathogenesis and possibly novel targets of IS.